Trocar Catheter Research Articles

Establishment of new transurethral catheterization methods for male mice.

Transurethral catheterization in mice is multifaceted, serving essential functions such as perfusion and drug delivery, and is critical in the development of various urological animal disease models. The complex anatomy of the male mouse urethra presents significant challenges in transurethral catheterization, leading to a predominance of research focused on female specimens. This bias limits the utilization of male mice in lower urinary tract disease studies. Our research aims to develop new reliable methods for transurethral catheterization in adult male mice, thereby expanding their use in relevant disease research. Experiments were conducted on adult male C57BL/6J mice. Utilizing a PE10 catheter measuring 4.5-5 cm in length, the catheter was inserted into the bladder via the mouse's urethra under anesthesia. The intubation technique entailed regulating the insertion force, ensuring the catheter's lubrication, using a trocar catheter, modifying the catheter's trajectory, and accommodating the curvature of the bladder neck. Post-catheter insertion, ultrasound imaging was employed to confirm the catheter's accurate positioning within the bladder. Subsequent to catheterization, the bladder was perfused using trypan blue. This method was further validated through its successful application in establishing an acute urinary retention (AUR) model, where the mouse bladder was infused with saline to a pressure of 50 or 80 cm H2O, maintained steadily for 30 min. A thorough morphological assessment of the mouse bladder was conducted after the infusion. Our study successfully pioneered methods for transurethral catheterization in male mice. This technique not only facilitates precise transurethral catheterization but also proves applicable to male mouse models for lower urinary tract diseases, such as AUR.

Description of a novel technique for surgical placement of gastrostomy tubes in dogs.

Early enteral nutrition in dogs with critical illnesses, including septic peritonitis, has been shown to have a positive influence on patient outcome. Surgical placement of a gastrostomy tube (GT) is one option for providing early enteral nutrition. Complications, including premature tube removal or separation of the stomach from the body wall, can result in leakage of gastric contents into the abdominal cavity and subsequent peritonitis. A safe and reliable technique for the placement of a GT is desirable to minimize such complications. A modified method for surgical placement of a GT is described. A thoracic trocar catheter (TTC) with an attached Pezzer tube is inserted through a gastrotomy incision and exited through the left gastric body and body wall. A left-sided tube gastropexy is performed using an interlocking box (ILB) pattern. GT placement using a TTC is efficient, requiring minimal additional anesthesia time. The gastric defect created by the TTC conforms well with the Pezzer tube. As such, placement and utilization of the ILB suture pattern enables removal of the GT in the early postoperative period, if appropriate.

胸骨圧迫が原因による著明な縦隔血腫から閉塞性ショックを来した1例(A case of obstructive shock from a severe mediastinal hematoma induced by chest compression)

心肺蘇生時の胸骨圧迫による合併症は比較的経験し，症例報告も散見される。しかし，胸骨圧迫によって縦隔血腫を合併し，閉塞性ショックにまで至った症例は非常に稀である。我々は胸骨骨折と内胸動脈損傷による縦隔血腫が原因で，閉塞性ショックを来した症例を救命したので報告する。症例は70歳の男性で，心肺停止状態で来院した。胸骨圧迫を継続しながら経皮的心肺補助装置を導入した。冠動脈造影検査で右冠動脈の閉塞を認め，閉塞部位に金属ステントを留置した。冠動脈カテーテル治療終了後に，単純CT検査を施行したところ，著明な縦隔血腫を認めた。縦隔血腫によって右心房が虚脱し，経皮的心肺補助装置の脱血が不良となった。緊急で剣状突起下からドレナージカテーテルを留置したが500mL/時の持続的な出血を認めたため，止血術を施行した。胸骨正中切開を行い，胸骨骨折部と左内胸動脈分枝部からの出血部をそれぞれ止血した。第4病日に経皮的心肺補助装置を離脱した。最終的に神経学的後遺症なく，長期臥床による廃用のリハビリテーション目的で転院した。 Complications due to chest compressions administered during cardiopulmonary resuscitation are relatively common. Only very rarely, however, does an obstructive shock resulting from a mediastinal hematoma occur. A 70–year–old male in cardiopulmonary arrest was admitted to the hospital. Percutaneous cardiopulmonary support was initiated as the chest compressions were continued. Coronary angiography showed occlusion of the right coronary artery, and a bare metal stent was placed at the occluded site. The patient was examined by CT after the percutaneous coronary intervention to check for complications from the percutaneous cardiopulmonary support. The CT images revealed a severe mediastinal hematoma. The percutaneous cardiopulmonary support had impeded the blood flow due to a compression of the right cardiac atrium and ventricle by the severe mediastinal hematoma. A trocar catheter was emergently inserted from below the xiphoid process. Continuous bleeding from the trocar catheter necessitated immediate hemostasis surgery. After a midline sternotomy, hemostatic treatment was applied to bleeding from the sternal fracture and branch of the left internal thoracic artery. The percutaneous cardiopulmonary support was removed on the fourth day after the surgery. The patient was ultimately transferred to another hospital for rehabilitation without neurologic deficits. CT examination can be useful for searching for fatal complications caused by chest compressions. 心肺蘇生時は質の高い胸骨圧迫を直ちに行うことが強く推奨されている 1。しかし一方で，胸骨圧迫による合併症も多数報告されている 2, 3。今回我々は，心肺蘇生時の胸骨圧迫によって胸骨骨折と内胸動脈損傷を合併し，縦隔血腫による閉塞性ショックを来した症例を救命したので報告する。 なお，倫理規定に関する事項は次の通りである。 ①倫理委員会が審査・承認すべき事項には該当しない。 ②個人情報保護に基づき，匿名化している。 ③患者および家族より論文の掲載に関して同意を得ている。 症 例：70歳の男性 主 訴：来院時心肺停止 既往歴：なし 現病歴：受診日の17時30分，商業店舗で商談中に卒倒し，17時32分から非番の消防職員によって胸骨圧迫が開始された。救急隊接触後の17時42分に心室細動が確認された。計5回のAEDによる除細動が施行されたが，自己心拍は再開しないまま，当院救命救急センターへ搬送された。 受診時現症：GCS（Glasgow coma scale）E1V1M1，心肺停止，瞳孔5mm/5mm，対光反射なし/なし 胸部単純レントゲン初見：心胸郭比48%，両側上肺野の透過性低下 II 誘導モニター心電図：心室細動 入院後経過：17時55分に当院救命救急センターに搬送された。初期波形が心室細動であり，アミオダロン300mg投与後の除細動でも効果を認めず難治性心室細動と診断した。当院での経皮的心肺補助装置（percutaneous cardiopulmonary support: PCPS）を用いた心肺蘇生術（extracorporeal cardiopulmonary resuscitation: ECPR）の導入基準に則り，心臓カテーテル室へ入室した。18時26分にPCPSを導入した（発症からPCPS導入まで56分）。PCPS回路はヘパリンコーティングされたものを使用し，3L/分の流量を保つように適時輸液負荷した。18時34分にヘパリン6,000単位を投与した。18時46分に150Jで除細動し洞調律を得た。12誘導心電図検査のII III aVf誘導でST–Tの上昇を認め，急性心筋梗塞と診断した。18時50分にACTを測定し283秒と延長していることを確認後，冠動脈造影検査（coronary angiography: CAG）を施行し，引き続き冠動脈カテーテル治療（percutaneous coronary intervention: PCI）を施行した。 CAG所見：右冠動脈（right coronay artery: RCA）（#2）の完全閉塞を認めた。左冠動脈に有意狭窄は認めなかった。 PCI所見：RCA（#2）部分の血栓を吸引し，血流が再開した。同部位にベアメタルステント（3.5×22mm）を留置し，TIMI（Thrombolysis in Myocardial Infarction Trial Grade）分類3の再灌流を得た（Fig. 1）。 Coronary angiography. a) Left anterior oblique view of the right coronary artery on coronary angiogrm. The right coronary artery was occluded (arrow). b) Left anterior oblique cranial view of the right coronary artery on angiogrm. A bare metal stent was placed in the right coronary artery (arrow heads). The right coronary flow improved. PCI終了後（20時30分頃）よりPCPSの流量が安定せず，乳酸リンゲル液やアルブミン製剤を急速投与した。PCI終了後に全身検索目的で，頭部から骨盤部までの単純CT検査を施行し，前縦隔に著明な縦隔血腫を認めた（Fig. 2）。また肺動脈，右房および右心室が壁外圧迫により虚脱していた。CT検査開始直後の20時55分頃からPCPSの脱血が不良となり，1L/分まで血液流量が低下した。右房が虚脱したため，脱血不良になったと判断した。輸液負荷によって2L/分まで血液流量が改善したため，そのままCT検査を施行した。集中治療センターに入室後，直ちに剣状突起下を小切開し前縦隔に16Frドレナージカテーテルを留置した（21時50分頃）。また，濃厚赤血球液および新鮮凍結血漿の輸血を開始した。ドレナージカテーテルによって閉塞性ショックから離脱し，十分な脱血が可能となったため脱血管の位置調整は施行しなかった。しかし，ドレナージカテーテルから500mL/時の持続的な出血を認め，断続的に濃厚赤血球および新鮮凍結血漿の輸血が必要な状態であった。23時00分に心臓血管外科に緊急開胸止血術を依頼し，24時00分から開胸手術を開始した。ヘパリン投与は初回6,000単位のみで，硫酸プロタミンは使用しなかった。 Plain CT performed after percutaneous coronary intervention. a) The pulmonary artery was compressed by a severe mediastinal hematoma (arrow head). b) Sternal bone fracture (arrow). The right atrium and right ventricle were compressed by the severe mediastinal hematoma (arrow heads). 手術所見：全身麻酔下で胸骨正中切開し，出血源を検索した。胸骨体の下1/3での骨折と，左内胸動脈の分枝からの拍動性の出血を認めた。胸骨骨折部からの出血は，挫滅も強く止血に難渋したが，電気メスによる焼灼と酸化セルロースで止血した。内胸動脈の分枝からの出血は止血クリップで止血した。また前縦隔部の血腫を除去し，心膜に損傷のないことを確認し，縦隔ドレーンを留置し閉創した。また，集中治療センターへ帰室後より，ヘパリンの持続投与を開始し，ACTが180–200秒前後になるよう，3時間ごとにモニタリングした。 術後経過：縦隔ドレーンからの排液は，術後第2病日に減少し抜去した。第4病日にはPCPSを離脱した。第6病日に胸部単純CT検査を撮影し，縦隔血腫は残存していたものの，右心系の圧排が解除されていることを確認した（Fig. 3）。神経学的後遺症は認めなかったが，長期臥床による廃用症候群を合併した。リハビリテーションによってADLは改善して，来院日から約6か月後にリハビリテーション目的で転院となった。 Plain CT was performed 6 days after operation. a) The mediastinal hematoma remained, however the pulmonary artery was not compressed. b) The mediastinal hematoma remained but the right atrium and right ventricle were not compressed. 心肺停止状態の患者に対する胸骨圧迫は，躊躇することなく行うべきであり，医療従事者のみならず，市民によっても行われている普遍的な手技である 1。一方で胸骨圧迫による合併症も多数報告されている 2, 3。本邦での胸骨圧迫の合併症に関するアンケート調査 4では，85.4%の医師が何らかの合併症を経験し，32.3%が胸骨骨折を経験している。しかし，心肺停止患者に対する胸骨圧迫が原因となり閉塞性ショックにまで至った報告は，我々の検索し得た範囲では4編5症例のみであった。うち3症例は本症例のように外科的止血術を施行し，2症例は血管内治療を施行している 5, 6, 7, 8。 本症例を救命することができた要因は，冠動脈カテーテル治療直後の単純CT検査で，縦隔血腫を早期に診断したことである。当院救命救急センターでは院外心肺停止症例に対して，積極的にPCPSを用いた心肺蘇生術（ECPR） 9を施行している。PCPS挿入時や管理中の出血合併症は致死的経過に至る可能性がある 10。そこで，PCPS挿入に伴う出血合併症の危険性を低減させるために，心臓血管カテーテル室に移動し透視下で挿入している。また，穿刺部や後腹膜の血腫の有無を確認する目的で，PCPSを挿入しCAG・PCIが終了した直後に，胸腹部単純CT検査を施行している。同時に低酸素脳症の評価目的に，頭部CT検査も施行している。当院は初療室・心臓血管カテーテル室・CT室が同一階に配置されているため移動時間が短いこと，ベッドではなくストレッチャーを用いてスペースを確保するなどの工夫によって，PCPS挿入中でも移動が可能となっている。 一般的にPCPSの脱血不良が発生した場合には，循環血漿量の不足を考える。しかし，充分な乳酸リンゲル液やアルブミン製剤の投与によっても改善を認めない場合は，PCIの合併症である冠動脈穿孔 11や，急性心筋梗塞自体の合併症である心破裂 12による心タンポナーデを疑い，経胸壁心臓超音波検査を施行することが考えられる。本症例ではCT検査を施行し縦隔血腫と診断できたため経胸壁心臓超音波検査を施行していないが，現在はECPR症例に対してはCAG・PCI終了後に心臓カテーテル室内で経胸壁心臓超音波検査を施行している。しかし，単純CT検査は簡便に縦隔血腫の有無を診断することができるため，経胸壁心臓超音波施行と併せて施行することが有用と考える。本症例はCT室内で脱血不良となり，縦隔血腫による右房の圧迫と診断が可能であった。脱血不良に対して輸液負荷で対応したが，CT室内で脱血管を下大静脈まで下げることによって，より早期に脱血不良から離脱する可能性があった。また，山岸ら 13は心肺停止の原因検索で冠動脈造影検査を行う症例では，事前にCTで出血性合併症の有無と出血源の同定をすることによって，冠動脈造影検査時にそのまま血管内治療に移行できるため有用であると報告している。当院では心臓血管カテーテル室でPCPSを挿入しているため，PCI終了後にCT室へ移動し出血性合併症の有無を検索している。 また，本症例を救命することができたもう一つの要因は，外科的治療を選択したことである。閉塞性ショックを呈していたため，早急に縦隔血腫をドレナージする必要があり，前縦隔にドレナージカテーテルを留置した 5。仮に閉塞性ショックを呈していなければ，保存的に経過観察する選択肢もある 8。出血性合併症に対する止血の方法として，血管内治療と外科的治療に分けられる。内胸動脈損傷に対しても血管内治療 13, 14と外科的治療 15の報告例がある。胸骨圧迫による縦隔血腫で出血源となり得るのは，内胸動脈や肋間動脈およびその分枝血管，胸骨や肋骨骨折からの出血である 16。血管内治療は低侵襲であるが，損傷部位が複数ある場合には出血源の検索に時間を要する。また，胸骨骨折の出血には対応できない。外科的治療は直視下で観察できるため，複数の出血源を同時に検索しやすく，止血処置も直視下で行えるため止血が得られやすい。しかし，血管内治療に比べると高侵襲である。本症例は持続する出血量を認め，出血源として胸骨骨折部分も考えられたため，直視下で観察できる外科的治療を選択した。実際，胸骨骨折からの出血も持続的に認めた。また，術中に止血を確認できたことによって，ヘパリンを早期に再開することができた。本症例のようなPCPS使用下では抗凝固療法を長期間中止しにくく，縦隔血腫によって閉塞性ショックにまで至るような場合には，緊急開胸止血術を施行し，確実な止血を得ることが有用である。 蘇生において最も基本的な手技である胸骨圧迫ではあるが，少なからず合併症を経験する。我々は胸骨圧迫によって，致死的な合併症にまで至る可能性があることを認識しておく必要がある。単純CT検査は胸骨圧迫による致死的合併症の縦隔血腫の有無を，簡便かつ迅速に検索でき有用である。 本論文に関連して開示すべき利益相反はない。

Peritoneal dialysis in neonates: six years of single center experience

Background/aim: Peritoneal dialysis (PD) is generally considered the practical dialysis modality for neonates in the treatment of acute kidney injury (AKI) and metabolic disturbances. The aim of this study was to evaluate the indications, complications, and outcomes of PD between January 2011 and December 2016. Materials and methods: This study included all 56 neonates that underwent PD over six years in our neonatal intensive care unit (NICU). A retrospective chart review was performed for all patients in our institution. Results: The incidence of PD was 1.32% (56/4230 patients) during this period. Mean birth weight of the patients was 2267.77 ± 1060.63 (540–5050) g. Thirty-four (60.7%) patients were premature. Fourteen patients (25%) were in the postoperative period of cardiac surgery due to congenital cardiac defects, fourteen patients (25%) were diagnosed with metabolic diseases, one patient had hypoxic ischemic encephalopathy, and another patient had severe pulmonary hypertension. Conclusion: In the acute setting of a neonatal intensive care unit, PD performed in a neonate provides a technically simple method of steady fluid, solute removal, and correction of electrolyte abnormalities. A trocar catheter appears safe even in premature babies, and closed three-way stopcock system seems to be reliable at the bedside in NICUs.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.

Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Trocar Catheter Transurethral Botulinum Toxin A Injection in Men With Spinal Cord Injury

ObjectiveTo evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). DesignDescriptive study. SettingHospital rehabilitation department. ParticipantsPatients (N=15; mean age, 40.5y; range, 22–64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. InterventionsA single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome MeasuresMaximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. ResultsAfter BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05). ConclusionsTransrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection.

Lung Injury Resulting from Fluted Silastic Soft Drain Extraction under Negative Pressure Suction*

We experienced two cases of lung injury resulting from fluted silastic drain extraction under reservoir-generated negative pressure suction. In the first case, a 67-year-old man underwent coronary artery bypass grafting. A 19 Fr BLAKE drain was placed at the pericardial cavity, the mediastinum, and the left thoracic cavity. All three drains were connected to J-VAC reservoirs. After removing the drains (which maintained the negative pressure), subcutaneous emphysema and hemopneumothorax occur. A trocar catheter was inserted. Bleeding and the air leak terminated within a day. In the second case, a 73-year-old man underwent aortic valve replacement. Right pneumothorax occurred after the removal of the pleural cavity drain, which maintained the negative pressure generated by the reservoir. We inserted a trocar catheter, and the air leak terminated within a day. We hypothesized that the reservoir-generated negative pressure causes the pleura to enter the groove of the drain and become damaged during extraction. We stopped using a reservoir to connect to the fluted silastic drain placed at the pleural cavity and removed the negative pressure when extracting the pleural cavity drain. Since implementing this change, we have not experienced a similar lung injury in more than 500 cardiac surgery patients.

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

IntroductionPulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old) boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter.Case presentationThe baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition.ConclusionsTherapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

Comparative Study for the Efficacy of Small Bore Catheter in the Patients with Iatrogenic Pneumothorax

BackgroundIt has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure.Materials and MethodsFrom March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications.ResultsThe most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered.ConclusionClosed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital.

•Single step therapy for abscess foci localized at different parts of the body using trocar type catheter: Results of two year-experience

Amac: Bu calismanin amaci goruntuleme esliginde per­kutan apse drenaji icin trokar tip kateterin kullanimini pra­tikligini ve ekonomik olup olmadigini arastirmaktir. Gerec ve Yontem: Haziran 2008-Aralik 2010 tarihleri ara­sinda farkli organ veya sistemlerde yerlesimli apsesi olan toplam 48 olgu, perkutan apse drenaji islemi icin girisim­sel radyoloji unitesine yonlendirildi. Hastalarin tumunde yas, apsenin yerlestigi organ veya vucut bolumu ve apse boyutu kaydedildi. Kirkiki (%87) olguda ultrasomografi esliginde, 6 (%13) olguda bilgisayarli tomografi esliginde islem yapilmis olup bir pediatrik hastada islem sedasyon anestezisi (remifentanil, midazolam) diger tum hastalarda lokal anestezi (prilokain hidroklorur) uygulandiktan sonra gerceklestirildi. Apse drenajinin saglandigi kateterizas­yon islemi, teknik olarak basarili kabul edildi. Bulgular: Kirk sekiz hastada (25 erkek, 23 kadin; yas ortalamasi 52 yil, yas araligi 2-82 yil) farkli organ veya sistemlerde yerlesimli apselere trokar tip kateterle gorun­tuleme esliginde perkutan apse drenaji islemi uygulandi. Teknik basari tum olgularda (%100) saglandi. Hicbir olgu­da islem sirasinda komplikasyon olmadi. Perkutan drenaj sonrasi kateterlerin cikartilma suresi 5-28 gun (ortalama 11.2 gun) idi. Splenektomi lojundaki apsesi basarili bir sekilde drene edilen bir olgu disinda nuks apse saptan­madi. Sonuc: Vucudun farkli lokalizasyonlarinda yerlesimli apselerin tedavisinde kolay uygulanabilir, tedavi maliye­ti ucuz, komplikasyon riski az bir yontem olan trokar tip kateterle goruntuleme esliginde perkutan apse drenaji oncelikli tercih olmalidir.

Percutaneous nephrostomy by direct puncture technique: An observational study

Percutaneous nephrostomy is the procedure of establishing a temporary drainage tract of the renal pelvi-calyceal system through the skin. This study aims to find out whether low cost trocar catheter can be a suitable substitute for the relatively high cost fluoroscopy/ultrasonography guided tract dilatation and tube insertion procedure. Percutaneous nephrostomy by the trocar catheter was performed in 126 patients. Under local anesthesia, a stab wound deep enough to traverse the muscle layer was made through which the trocar - catheter drainage set was inserted under ultrasonography guidance. About 179 procedures were performed in 126 patients. Primary technical success rate was 94%, major complication rate 1.6%, minor complication rate 11% and catheter related complications like catheter blockage or dislodgement were 13%. There was no procedure related mortality in our series. The ultrasonography-guided trocar, catheter nephrostomy, is a quick, safe and low cost procedure in selected cases of upper urinary tract obstruction. The primary technical success and complication rates are comparable to any other reported procedure and its low cost is particularly suitable for developing countries like India.

Sonographically Guided Transvaginal or Transrectal Pelvic Abscess Drainage Using the Trocar Method with a New Drainage Guide Attachment

In this article, we describe a drainage guide attachment that allows trocar catheter placement for abscess drainage using the transvaginal or endorectal route under sonographic control. This drainage guide attachment has a central groove for catheter placement and a removable cover. Thus, the cover may be removed after catheter placement to allow the catheter to stay in place while the rest of the drainage guide attachment and the ultrasound probe are removed from the patient. Our findings indicate that a new sonography drainage guide attachment can be used for endorectal or endovaginal trocar catheter drainage of pelvic abscesses.

A new sterilization technique with balloon-tube thoracostomy for thoracic empyema.

Failure or prolongation of treatment for refractory thoracic empyema by the current chest-tube drainage technique is often due to sterilization difficulties. Insufficient sterilization prolongs hospitalization, and is often associated with life-threatening complications and/or additional invasive surgical procedures. A new chest-tube sterilization technique aimed at making it less invasive and shortening the therapy is proposed. Following pretreatment for complications including loculation, bronchopleural fistula, or corticated lung, a double-lumen trocar catheter was introduced at the bottom of the empyemic cavity through the lateral chest wall. Then, a Foley balloon urethra-catheter was inserted and attached just inside the anterior chest wall at the top of the cavity for the evacuation of intrathoracic air. After irrigation of the cavity with distilled water once or twice, the cavity was completely filled with a bactericidal solution which was left in place for 30-60 minutes, followed by an antibiotic solution for more than 20 hours. Among the five treated post-lobectomy or pneumonectomy cases, sterilization was obtained after only one treatment in four cases and after two courses in the other. Catheterization duration from the initial treatment was 2-13 days. Neither recurrence nor treatment-related major complications were observed. This balloon-tube thoracostomy technique is simple, minimally invasive and cost-effective, due to shortening of the treatment time with minimal manpower and equipment requirements. It is thus a promising therapeutic approach to thoracic empyema and has the potential for application to other intrathoracic disorders.

Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage.

Transvaginal ultrasonographically (US) guided procedures are simple and safe and often represent the only means of access to pelvic disease. Aspiration of cystic pelvic masses and core biopsy of solid pelvic masses can be easily performed by using the transvaginal route, an endoluminal US transducer, and a needle guide. Because of concerns about false-negative diagnosis and potential tumor seeding with biopsy of primary ovarian cystic lesions, the indications for transvaginal aspiration and biopsy of ovarian and adnexal lesions are predominantly therapeutic. Similarly, using an endoluminal probe with modification of the guide, one can also perform safe and effective trocar catheter drainage of pelvic abscesses via the transvaginal route. The transvaginal route is ideally suited to pelvic abscess drainage because of the proximity of the vaginal fornices to most pelvic fluid collections. The transvaginal route has the disadvantage of being semisterile; because of the risk of superinfecting previously noninfected pelvic pathologic conditions, the transvaginal approach should be used only for solid lesions or cystic lesions that can be completely aspirated. Familiarity with the transvaginal route of access is crucial for adequate treatment of many gynecologic and nongynecologic pelvic pathologic conditions.

New use of Argyle trocar catheter: treatment of pelvic abscess following transvaginal ultrasound-directed follicle aspiration (UDFA).

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound-directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvic abscesses appears to be simple and effective.

Acute peritoneal dialysis in preterm newborns and small infants: Surgical management

Experience with acute peritoneal dialysis gathered over the last 10 years shows that, in 63 premature newborns and infants (up to 1 year of age), a standardized surgical procedure using a silicone catheter with a Dacron cuff (individually glued to fit) has a lower complication rate and is more effective than placement of a trocar catheter.

Percutaneous drainage of splenic abscesses: an effective and safe procedure.

Percutaneous drainage of splenic abscesses has not yet become a common procedure due to the potential risk of bleeding and the danger of damage to neighbouring organs. We present our experience of percutaneous drainage in eight patients with splenic abscesses. Four patients were treated by therapeutic percutaneous needle aspiration of the fluid collection, and four by percutaneous trocar catheter insertion. All procedures were guided by ultrasound or computed tomography. The procedure was successful in all eight patients with no complications.

Perinephric Abscesses: Percutaneous Versus Open Surgical Drainage

Perinephric abscess in the past was associated with high morbidity and mortality rates. Standard therapy has included antibiotics and open surgical drainage. The advent of sonography and computed tomography has facilitated the diagnosis and treatment via percutaneous drainage. A retrospective search yielded 16 cases of perinephric abscesses at our institution between January 1980 and January 1990. Each case was evaluated with regard to age, sex, predisposing factors, diagnostic tests, treatment modality, morbidity and mortality. Seven patients underwent percutaneous drainage by either a Seldinger or trocar catheter techique. Six of these had successful drainage. The one unsuccessful case was a patient with an infected hematoma, which was treated successfully with open surgical drainage. Nine patients initially underwent open surgical drainage. Five also had nephrectomies for renal scan-documented nonfunctioning kidneys that contained renal caluli. Of the remaining four patients, one had a staghorn calculu...

Low pelvic abscesses: A technique of drainage using a small trocar catheter

A low anterior pelvic abscess can be drained transrectally using a 16 F. trocar catheter or chest tube. The tube is anchored intrarectally for dependent drainage or for irrigation with a normal saline solution or an antibiotic solution. A low posterior pelvic abscess secondary to a low anterior resection can be drained transperineally in the same manner.